Transition of Care

We understand the importance of maintaining your health coverage without any interruption in your medical treatments or prescription medications. These steps will help you make a smooth transition switching over to the Optima Health Plan.

Are you eligible for the incentive program?

Optima Health Incentive Program includes benefits that start each plan year. Since the plan year has already started on July 1, we are only accepting members who are new hires or newly diagnosed. The Optima Health Incentive Program is available to members with one or more of the following chronic conditions: Asthma/COPD, Diabetes, or Hypertension. If you are diagnosed with one of these conditions mid–year, or you are a new hire after July 1, 2019 you may be eligible for some of the program benefits. Contact us to learn more.


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What are your needs?

  • If have (Asthma/COPD, Diabetes, or Hypertension), what steps do I take to receive the financial incentive?

    • If you have one of the following chronic conditions (Asthma/COPD, Diabetes, or Hypertension), you may be eligible for a financial incentive.

      The Optima Health Incentive Program includes benefits that start each plan year. Since the plan year has already started on July 1, we are only accepting members who are new hires or newly diagnosed. If you are diagnosed with one of these conditions mid–year, or you are a new hire after July 1, 2019 you may be eligible for some of the program benefits. Contact us to learn more.

  • If I have a chronic condition, how do I transition care?

  • I currently receive obstetrics care, medical treatment, or have a procedure scheduled

    • Call your doctor's or specialist's office and tell them you are changing my coverage to Optima Health.
    • Ask your doctor to send any clinical notes and authorizations to the Optima Health Clinical Care Services team.
  • I am scheduled for treatment that required an authorization

    • Optima Health will likely need to authorize this treatment. Please contact us.
  • I need refills for my prescriptions

    • Tell your prescribing doctor you will be switching your coverage to Optima Health.
    • If possible, get your prescription refilled in advance of your change in coverage.
  • My prescription requires prior-authorization*

    • For all members newly enrolling with Optima Health currently taking prescriptions requiring prior authorization, Optima Health will temporarily waive prior authorization requirements if your prescription is filled within:
  • Your Member ID card

    • Present your new member ID card to your doctor’s office and pharmacy so they can update your records

Exclusions:*

    1. Drugs prescribed outside of any age restriction, above a quantity limit, or above sale maximum daily dosage limits.
    2. All adult stimulants.
    3. Drugs excluded by the plan such as fertility or cosmetic drugs.